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Drugs like phenytoin, metformin, and methotrexate can interfere with folate absorption or metabolism

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While there is no corroborative clinical trial data, animal experiments suggest that hydroxocobalamin produces a time and organdependent, selective regulation of nitric oxide synthases during endotoxemia and regulates downstream inflammatory mediators, thereby having a potential role in the treatment septic shock 4

Worsening neurological symptoms : Progressive weakness, worsening balance problems, or deteriorating cognitive function despite treatment requires urgent assessment